Abstract
Background
Boxer's fractures are the most common type of metacarpal fracture. It commonly occurs during fistfights or from punching a wall. Greer et al demonstrated that it is usually an intentional injury and these patients were at increased risk for recurrent injury (2). Further work suggested that patients with such injuries had higher features of antisocial, self- harm and impulsive behavior, compared with control groups (3).
There is little that has been reported on children and adolescents who present with such fractures.
This study aims to assess aggression scores in young patients with metacarpal fractures due to punching using a validated questionnaire.
Methodology
Following ethical permission, 11–18 year olds, with a boxers fracture and willing to complete an anonymous questionnaire were included. If they were under 16, parental permission was sought. The Buss and Warren validated questionnaire included subscales of physical aggression and anger scales as well as overall aggression scoring.
Results
48 patients who had metacarpal fractures due to punching have completed the study to date. There were 46 males and 2 females.
The physical aggression scores ranged from 11–40 with a mean of 25, median 35.5 and mode 14. 24 patients demonstrated high aggression scores.
Anger scores ranged from 7–33. Mean 19, mode 13, median 18.5. 18 patients demonstrated high anger scores. Overall aggression scores ranged from 43–148 with a mean of 96 and median of 92.5. Nineteen patients demonstrated high scores.
Discussion
This study shows that 40% of the patients had higher overall aggression levels than the normal population.
The physical aggression subscale focused on the use of physical force and 50% had high physical aggression levels. High scores in this subscale indicate a lack of ability to control urges toward physical aggression and this is often seen in children with attention deficit disorder.
Anger scores may indicate a number of conduct disorders/abusive situations and in this study 38% had raised anger scores. This may be relevant in assessing children with punch injuries as they may benefit from assessment by the CAMS team for investigation and management of their anger and aggression issues, which in turn may reduce recurrence of the injuries.
